Invoice #1042
Nov 4, 2026, 5:35 PM
Summary
Awaiting payment
| Item | Qty | Price | Amount |
|---|---|---|---|
| Composite filling | 1 | $355.00 | $355.00 |
| Routine cleaning and exam | 1 | $200.00 | $200.00 |
Total$555.00
Outstanding$555.00
Patient
Name
Email
julia.fischer@example.net
Phone
(630) 555-0117
Payment
Status
Awaiting payment
Due
Nov 18, 2026